br In addition there was no significant
In addition, there was no significant difference in CRP levels among premenopausal and post-menopausal breast cancer patients (P > 0.05). Higher and moderate CRP levels associated signifi-cantly with death (P = 0.02) as well as metastasis and recurrence (P = 0.03). Therefore moderate and high CRP levels associated significantly with poor outcome including death, recurrence, and metastasis.
The strength of the study lies in the fact that it is a prospective study with blinding of those who assessed the follow-up events. To the best of our knowledge there is no published literature on CRP in association with cancer outcome till date. Therefore the study was carried out in Malwa region of Punjab, where breast cancer is most common type of malignancy in females. The aim of the study was to evaluate if CRP can be used as a prognostic marker in breast cancer patients from this region. The levels of CRP were assessed at the time of disease diagnosis and the outcome measures were robust. However, limitations of the study are that we could not collect data on the tumor size and Oxaliplatin node status.
In conclusion, the present study indicates that the elevated levels of CRP are associated with increased risk of breast cancer in Malwa region of Punjab. Risk of mortality, recurrence, and metastasis among women diagnosed with breast cancer associated significantly with the
elevated levels of CRP. Therefore, the present study combined with previous research confirms that circulating CRP levels associated significantly with increased risk of poor outcome in breast cancer patients. However, none of the previous studies as well as this study determines whether this association is causal. If CRP plays a causal role in breast cancer outcome then the future researchers need to focus on understanding how interventions can reduce the circulating con-centration of this inflammatory marker. In accordance with Villasenor et al, if CRP is simply a prognostic marker then future studies are required to understand if it is responsive to drug and lifestyle interventions designed to reduce the risk of recurrence.7
The authors are thankful to rural medical o cers Dr. Amanpreet Kaur and Dr. Gurdarshan Singh for their valuable help in collection of control samples.
1. Finn R-S, Crown J-P, Lang I, et al. The cyclin-dependent kinase 4/6 inhibitor palbociclib in combination with letrozole versus letrozole alone as first-line treatment of oestrogen receptor-positive, HER2-negative, advanced breast cancer (PALOMA-1/TRIO-18): a randomised phase 2 study. Lancet Oncol. 2015;16:25–35.
4. Blaurock-Busch E, Busch Y-M, Friedle A, et al. Comparing the metal concentration in the nails of healthy and cancer patients living in the malwa region of punjab, india with a random european group-a follow up study. Br J Med Med Res. 2015;5:480.
6. Wulaningsih W, Holmberg L, Abeler-Doner L, et al. Associations of C-reactive protein, granulocytes and granulocyte– to-lymphocyte ratio with mortality from breast cancer in non-institutionalized American women. PLoS One. 2016;11.
7. Villaseñor A, Flatt S-W, Marinac C, et al. Postdiagnosis C-reactive protein and breast cancer survivorship: findings from the WHEL study. Cancer Epidemiol Biomark Prev. 2014;23:189–199.
8. Allin K-H, Nordestgaard B-G, Flyger, et al. Elevated pre-treatment levels of plasma C-reactive protein are associated with poor prognosis after breast cancer: a cohort study. Breast Cancer Res. 2011;13:1.
9. Favaro E, Amadori A, Indraccolo S. Cellular interactions in the vascular niche: implications in the regulation of tumor dormancy. Apmis. 2008;116:648–659.
11. Basu S, Harris H, Larsson A, et al. Is there any role for serum cathepsin S and CRP levels on prognostic information in breast cancer? The Swedish mammography cohort. Antioxid Redox Signal. 2015;23:1298–1302.
12. Ridker P-M, Cook N. Clinical usefulness of very high and very low levels of C-reactive protein across the full range of Framingham risk scores. Circulation. 2004;109:1955–1959.
13. Rajeshwar K, Kaul S, Al-Hazzani A, et al. C-reactive protein and nitric oxide levels in ischemic stroke and its subtypes: correlation with clinical outcome. Inflammation. 2012;35:978–984.
14. Schmid M, Schneitter A, Hinterberger S, et al. Association of elevated C-reactive protein levels with an impaired prognosis in patients with surgically treated endometrial cancer. Obstet Gynecol. 2007;110:1231–1236.
16. Allin K-H, Bojesen S-E, Nordestgaard B-G. Baseline C-reactive protein is associated with incident cancer and survival in patients with cancer. J Clin Oncol. 2009;27:2217–2224.